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Human papillomavirus 9-valent vaccine recombinant cpt

Studiile recente subliniazã creºterea explozivã a acestor infecþii, HPV fiind unele dintre cele mai frecvente virusuri cu transmitere sexualã - aproximativ milioane de cazuri în întreaga lume conform statisticilor WHO, Diagnosticul infecþiei genitale externe de etiologie HPV include: examenul direct, diagnosticul de laborator - cu diagnosticele histopatologic, molecular ºi serologic - ºi diagnosticul diferenþial.

Un diagnostic precoce ºi complex va human papillomavirus 9-valent vaccine recombinant cpt la instituirea unui tratament adecvat, a prevenþiei recurenþelor, cât ºi la reducerea imensului rezervor infecþios reprezentat de persoanele contaminate cu HPV. Cuvinte cheie: infecþii genitale externe, diagnostic, virusuri papilloma umane HPV. Recent studies underline the explosive increase in the prevalence of these infections, HPV being one of the most frequent sexually transmitted viruses - approximaely million cases worldwide according to WHO statistics.

The diagnosis of the external genital infection with HPV includes the direct examination of the patient, the laboratory papilomatosis dermatologia - histopathological, molecular and serologic diagnosis - and the differential diagnosis. A prompt and complex diagnosis helps in the initiation of adequate treatment, in the prevention of future relapses, as well as in the reduction of the huge infectious reservoir represented by the HPV contaminated persons.

Keywords: external genital infections; diagnosis; human papilloma virus HPV. Introducere Virusurile papilloma umane HPV sunt rãspândite global, prevalenþa lor fiind destul de dificil de apreciat din cauza lipsei de teste standard pentru diagnostic, mai simple ºi cu preþ de cost scãzut.

Studiile recente subliniazã 1. Introduction Human papilloma vuruses HPV have a global distribution, their prevalence being human papillomavirus 9-valent vaccine recombinant cpt difficult to determine due to the lack of standardized, simple and cheap diagnostic tests. Aspectele clinice, în aria genitalã externã, sunt diverse ºi pot coexista, de la infecþiile subclinice la cancere invazive.

Astfel, se descriu: veruci tegumentare vulgare ºi plane, epidermodisplazii veruciforme, hiperplazii focale epiteliale, papuloza bowenoidã, cancere genitale externe. Aspectul leziunilor depinde ºi de zona afectatã: localizarea pe zonele cu epiteliu sau epiderm bine keratinizate duce la apariþia unor zone keratozice ce seamãnã cu verucile vulgare; localizarea pe zone cu þesuturi laxe duce la formarea de condiloame acuminate; localizarea pe zone umede ºanþ balano-prepuþial, meat uretral, mucoasã vaginalã, mucoasã sau vestibul anal duce la formarea de condiloame moi la palpare, exofitice, de culoare roºie [3,4].

Au fost descrise cazuri de contaminare viralã a copiilor datoritã abuzurilor sexuale [8,9,10].

Звучит интригующе. - Мы с Мариусом несколько недель должны будем оставаться здесь, - проговорила Эпонина, обращаясь к Максу. - Поэтому неделю можно подождать без всяких проблем. В этот момент в дверь постучался Синий Доктор. Октопаук вошел в спальню со специализированным оборудованием: с его помощью он собирался обследовать Мариуса.

Presently, it is estimated that more than 50 HPV types can infect the genital human papillomavirus 9-valent vaccine recombinant cpt, the risk of HPV contamination being highest during the first years of an individual s sexual life [1,2].

The clinical aspects of the HPV infection of the external genital area are diverse and can coexist, ranging from subclinical infections to invasive cancers. The following forms are described: common and flat cutaneous warts, veruciform epidermodysplasia, focal epithelial hyperplasia, bowenoid papulosis and external genital cancers.

The aspect of the lesions also depends on the affected area: localization of the infection to human papillomavirus 9-valent vaccine recombinant cpt keratinized epidermis leads to the appearance of keratotic lesions resembling common warts; localization in areas with lax tissues leads to the formation of condyloma acuminatum; localization in moist areas the balanopreputial sulcus, urethral meatus, vaginal mucosa, anal mucosa or vestible leads to the formation of soft, exophytic, red colored condylomas [3,4].

Cases of viral contamination of sexually abused children have also been described [8,9,10].

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Co-factorii adjuvanþi implicaþi în infectarea cu HPV sunt: imunosupresia consecutivã sarcinii, transplantului de organ, bolii neoplazice deja instalate sau infecþiei HIVfumatul, co-infecþiile virale ºi bacteriene coinfecþia cu virusurile herpes simplex 1 ºi 2, cu Chlamydia trachomatis, cu Trichomonas vaginalis, cu HIVdeficienþe nutriþionale deficienþe de vitamine C, A, de folaþi, de micronutrienþistimularea progesteronicã contracepþia hormonalã ºi de predispoziþia geneticã [11,12,13,14,15].

Cãile de transmitere sunt: prin contact sexual, pe verticalã de la mamã la fãtorizontalã contact direct cu human papillomavirus 9-valent vaccine recombinant cpt infectatã, contract prelungit cu îmbrãcãmintea contaminatã ºi iatrogenã biotom, instrumente de colposcopie nesterilizate.

Susceptibilitatea este generalã, mult crescutã la indivizii cu imunosupresie [2,6,16,17]. Adjuvant cofactors for HPV infection are: immunosupression subsequent to pregnancy, organ transplant, neoplasm or HIV infectionsmoking, viral and bacterial coinfections coinfection with herpes simplex virus 1 and 2, Chlamydia trachomatis, Trichomonas vaginalis, HIVnutritional deficiencies vitamin C, A, folat, micronutrients deficiencyprogesteron stimulation hormonal contraception and genetic predisposition [11,12,13,14,15].

Transmission of the virus takes place via sexual contact, vertically from mother to fetus human papillomavirus 9-valent vaccine recombinant cpt, orizontally direct contact with infected skin, prolonged contact with contaminated clothes and egg of oxyuris equi biotom, colposcopy instruments that are not sterilized. Susceptibility is general, but much increased in immunosupressed individuals [2,6,16,17].

Diagnosticul de laborator al infecþiilor genitale human papillomavirus 9-valent vaccine recombinant cpt induse de HPV, de uz curent, se face prin evidenþierea ADN viral în celulele infectate, prelevate din leziuni, ºi, în human papillomavirus 9-valent vaccine recombinant cpt micã mãsurã, prin evidenþierea proteinelor virale în þesuturi.

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Produsele biologice utilizate pentru testãri sunt reprezentate de: fragmente de condiloame excizate chirurgicalraclaje din leziunile genitale externe atipice, prelevate din uretrã mai ales pentru leziuni localizate la nivelul meatului uretral la bãrbaþi.

Diagnosticul de laborator cuprinde: diagnosticul histopatologic, diagnosticul molecular ºi diagnosticul serologic [18] Diagnosticul histopatologic, util în cazul diagnosticului incert, pune în evidenþã aspecte specifice infecþiei genitale cu HPV human papillomavirus 9-valent vaccine recombinant cpt, mai ales, poate evidenþia leziunile displazice sugestive pentru cancere cutanate în zonele genitale externe.

În cazul condiloamelor genitale externe aspectele histopatologice constau în: papilomatozã, cu dimensiuni variate, în funcþie de tipul leziunii tegumentare planã sau acuminatã ; diskeratozã para - sau hiperkeratozã ; acantoza epiteliului dermoid fãrã modificarea straturilor bazale ; koilocitozã caracteristicã infecþiei celulei - gazdã cu HPV : halou citoplasmatic nuclear, nucleu celular mãrit, hipercromatic, uneori atipii nucleare ºi mai mulþi nuclei prezenþi.

Ani Fig. Tendinţa mortalităţii la copiii sub 5 ani la nivel mondial Fig. Constantin N. Iordache În ultimele două decenii, noi preparate vaccinale asigură o protecţie de bună calitate împotriva a trei microorganisme: pneumococ, rotavirus şi papiloma virus uman HPV.

Pentru leziunile displazice localizate la nivelul tegumentelor genitale externe sugestive pentru cancere cutanate, aspectele histopatologice întâlnite sunt extrem de polimorfe, predominând hiperplazia epitelialã, hiperkeratoza ºi hiperacantoza. Evoluþia spre un cancer de piele este semnalatã de mãrirea în volum a leziunii displazice, indurarea bazei, accentuarea hiperkeratozei, ulcerare, fisurare, examenul histopatologic urmând apoi protocolul de diagnostic al cancerelor de piele [4] Diagnosticul molecular.

EN_RO Glossary

Deoarece HPV nu poate fi cultivat în sisteme clasice de culturi de celule, cea mai eficientã metodã de diagnostic de laborator al infecþiilor genitale externe induse de HPV este decelarea ADN viral cu ajutorul tehnicilor de biologiemolecularã. Evidenþierea genotipurilor cu risc crescut este 2. The laboratory diagnosis of HPV external genital infections is currently performed by the identification of viral Human papillomavirus 9-valent vaccine recombinant cpt in infected cells prelevated from the lesions and, to a lesser extend, by the identification of viral proteins in tissues.

The biological products tested are: fragments of condylomas surgically excisedscrapings from atypical external genital lesions, samples prelevated from the urethra especially for lesions localized at the urethral meatus in men. The laboratory diagnosis encompasses the histopathological, molecular and serological diagnosis [18] The histopathological hpv impfung verlauf is human papillomavirus 9-valent vaccine recombinant cpt in the case of uncertain clinical diagnosis.

It identifies the specific aspects of HPV genital infection, as well as dysplastic lesions suggestive of skin cancer.

In the case of external genital condylomas, the histopathological changes are: papilomatosis of various degrees, depending on the type of the skin lesion flat or acuminated ; dyskeratosis para - or hyperkeratosis ; acanthosis of the dermoid epithelium without changes of human papillomavirus 9-valent vaccine recombinant cpt basal layer ; koilocytosis characteristic of HPV infection of the host cell : nuclear cytoplasmic halo, enlarged and hyperchromatic nucleus, occasionally with nuclear atipies and multiple nucleols.

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In dysplastic lesions localized in the external genital area suggestive of skin cancers, the histopathologic aspects are extremely polymorphic, the predominating features being epithelial hyperplasia, hyperkeratosis and acanthosis. Evolution towards a skin cancer is signaled by enlargement of human papillomavirus 9-valent vaccine recombinant cpt dysplastic lesion, by the induration of its base, accentuation of the hyperkeratosis, ulceration, fissuration of the lesion, the histopathologic exam therefore following the diagnostic protocol for skin cancer [4] The molecular diagnosis.

As HPV can not be cultivated in classical systems of cell cultures, the most efficient laboratory diagnosis method for external genital HPV infections is the identification of viral DNA with the aid of molecular biology techniques. The 78 5 importantã în screening-ul primar ºi în human papillomavirus 9-valent vaccine recombinant cpt pacienþilor cu leziuni minore ºi infecþie persistentã cu un genotip human papillomavirus 9-valent vaccine recombinant cpt risc crescut de HPV, precum ºi dupã terapie în scopul identificãrii recurenþei virale [18,19,20].

Tehnicile de laborator utilizate sunt tehnici de extracþie a acidului nucleic viral, tehnici de hibridizare ºi tehnici de amplificare a genomului viral. Cele mai folosite tehnici de hibridizare sunt: - Southern blot, dot blot; dezavantajele sunt: necesitã o cantitate mare de produs biologic, au sensibilitate scãzutã, necesitã timp crescut de lucru ºi personal specializat; - hibridizarea in situ: detectarea acidului nucleic viral în frotiuri celulare sau secþiuni histologice test comercial Inform HPV - Ventana Medical Systems ; - tehnica Hybride Capture HC I ºi HC II - Digene Corporation detecteazã direct acizii nucleici - papillomavirus luette, folosind amplificarea semnalului; genotipurile de HPV pe care le detecteazã HC II sunt: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, Tehnica de amplificare a genomului viral, de uz curent, este PCR reacþia de amplificare a polimerazei, teste comerciale ; tehnica constã în generarea rapidã a unor copii multiple ale unei secvenþe nucleotidice - þintã ADN sau ADNc dintr-o genã de interes; tehnica detecteazã ADNul viral, dar nu evidenþiazã genotipul; utilã pentru investigaþii epidemiologice, dar tehnologia necesarã ºi costurile sunt foarte mari pentru un diagnostic de rutinã [18,19,20].

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The laboratory techniques utilized are viral nucleic acid extraction techniques, hibridization techniques and amplification techniques of the viral genome. The most frequently used hibridization techniques are: - Southern blot, dot blot; their disadvantages are: they necessitate a large quantity of biologic matherial, have a low sensitivity, are time consuming and can only be performed by specialized personnel; - in situ hibridization detects the viral nucleic acid in cellular smears and histologic sections commercial test Inform HPV - Ventana Medical Systems ; - Hybride Capture technique HC I and HC II - Digene Corporation directly detects target nucleic acids, using signal amplification; the HPV genotypes HC II detects are: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, The amplification technique of the viral genome most often used is the polymerase chain reaction PCR that consists of the rapid generation human papillomavirus 9-valent vaccine recombinant cpt multiple copies of a target nucleotidic sequence DNA or DNAc from a gene of interest; the technique detects viral DNA, but does not identify the exact genotype; it is useful in epidemiologic studies, but the necessary technology and the costs are too high for routine diagnosis [18,19,20].

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Secvenþierea acidului nucleic viral este utilizatã, deocamdatã, pentru studii predictive [18]. Tehnica microarray, recent apãrutã, în curs de evaluare, va genera rezultate rapide cu costuri minime, studiile recente arãtând cã sensibilitatea ºi specificitatea sunt similare cu HC II [21] Diagnosticul serologic. Evidenþierea anticorpilor anti HPV nu e un test de rutinã. ELISA, efectuatã cu antigene recombinante specifice obþinute doar prin inginerie geneticã, este utilizatã, deocamdatã, pentru studii epidemiologice ºi pentru evaluarea anticorpilor anti HPV postvaccinare stabilirea titrului de anticorpi protectori ºi a persistenþei acestuia - în curs de studiu [18] Diagnosticul diferenþial al condilomatozei genitale externe de etiologie HPV confirmatã se face cu: condiloma plata a sifilisului secundar sau sifilidele papulo-hipertrofice, maladia Bowen, nevul verucos perivulvar, perianal cu aspect keratozic, micropapilomatoza labialã papile vestibularepapule perlate peniene, veruci seboreice, molluscum pendulum, molluscum contagiosum, cancerul ano - genital forme clinice similare vegetaþiilor veneriene [4].

Un diagnostic precoce ºi complex va ajuta la instituirea unui tratament adecvat, a prevenþiei recurenþelor, cât ºi la reducerea imnesului rezervor infecþios reprezentat de persoanele contaminate cu HPV [22]. Viral nucleic acid sequencing is only used in predictive studies [18].

IATE_EN_RO

The recently developed microarray technique, currently under evaluation, will generate rapid results with minimal expense, recent studies showing its sensitivity and specificity are similar to HC II [21] The serologic diagnosis. The detection of anti HPV antibodies is not a routine test. ELISA, performed with specific recombinant antigens obtained only by means of genetic ingineering is presently used in epidemiological investigations and for the evaluation of the presence of postvaccination anti HPV antibodies in order to determine the protective antibody titre and its persistence - currently under study [18].

The differential diagnosis of confirmed HPV external genital condylomatosis is made with: condyloma plata present in secondary sifilis or papulo-hypertrofic sifilids, Bowen disease, verucous perivulvar, perianal nevus with a keratotic aspect, labial micropapilomatosis, penile perlate papules, seborrheic keratoses, molluscum pendulum, molluscum contagiosum, anogenital cancer the clinical forms similar to condyloma acuminatum [4].

Human Papillomavirus (HPV) Statistics - Did You Know?

A prompt and complex diagnosis helps in the initiation of adequate treatment, in the prevention of future relapses, as well as in the reduction of the huge infectious reservoir represented by the HPV contaminated persons [22]. Michelle Forcier, Najah Musacchio. An overview of human papillomavirus infection for the dermatologist: disease, diagnosis, management, and prevention.

DIAGNOSTICUL INFECÞIILOR GENITALE EXTERNE INDUSE DE VIRUSURILE PAPILLOMA UMANE (HPV)

Dermatologic Therapy, Vol. Clin Infect Dis. Boli transmise pe cale sexualã. Editura Celsius, Bucureºti, The epidemiology of genital human papillomavirus infection. Vaccine, ; 24 Suppl 1: S 7 6. Epidemiology and natural history of genital human papillomavirus infection.

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J Am Osteopath Assoc. Partridge J. Lancet Infect Dis Jan; 6 1 : Review. HPV infection în men. Dis Markers, ; 23 4 : Genital human papillomavirus papillomatosis atypia în the male sexual partners of women with isolated vulvar lesions. J Gynecol Cancer. Obstet Gynecol.

Arch Pediatr Adolesc Med. Scand J Infect Dis. B, Abrahamsen M. Cancer Epidemiol Biomarkers Prev Jun;16 6 : The spectrum and clinical sequelae of human papillomavirus infection. Gynecol Oncol. Rev Esp Quimioter.

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Uezato H. Oshiro M. Gynecologic Oncology ; 89 2 : Dempsey A.